CANNABIS IN THE CURRICULUM

USC Med School Takes The Lead

"Any pain-management training that does not have information about cannabis
is committing malpractice." -Claudia Jensen, MD

On Feb. 13 students and faculty from the University of Southern California
Keck School of Medicine put on a half-day program devoted to the clinical
uses of cannabis and the relevant pharmacology. Some 30 first- and
second-year med students attended the history-making event in McKibben
Hall, which was organized by Rolando Tringale, a second-year med student,
and Claudia Jensen, MD, a Ventura pediatrician who is an Instructor in the
Department of Family Medicine.

Jensen teaches "Introduction to Clinical Medicine," in which first-year
students learn how to take a patient's history and conduct a physical exam.
Since the Fall semester of 2001 Jensen has spent a full day in the ICM
class talking about cannabis and bringing in patients for students to
interview. "They're open-minded and well educated," she says of her
students. "And they actually go on to teach their colleagues the truth
about cannabis. That's why Rolando wanted to do this
presentation." (Tringale had taken Jensen's ICM class last year.)

The Feb. 13 program started with first-person accounts from patients.
Jensen had invited Ishmael Gayes, nicknamed Eddie Green, "a paraplegic -a
very beautiful, intelligent, spiritual black man who was shot in the back
over a woman when he was 17;" chronic pain patient Lisa Cordova Schwarz;
and glaucoma patient Jim Carberry. Bill Britt, an activist from Long Beach
who has post-polio syndrome and epilepsy, also described his use of cannabis.

Joseph Miller, PhD, associate professor of Cell and Neurobiology, discussed
the pharmacology and biochemistry of the body's own cannabinoid receptor
system, which is activated by THC and other compounds in the plant.
Miller's research has been funded over the years by the National Institute
on Drug Abuse. "He's not a medical marijuana protagonist," says Jensen,
"he's not in the movement. He's just an honest man with a balanced,
truthful perspective about drugs who was willing to be a speaker."

Psychology professor Mitch Earleywine, PhD, discussed the question of
safety. Earleywine, the author of Understanding Marijuana (Oxford, 2002),
said that medical users could minimize negative consequences by vaporizing
instead of smoking. Earleywine also advocates "keeping dosage at a level
that relieves symptoms but doesn't create any impairment" and "monitoring
for any signs of craving that might indicate tolerance or withdrawal."
Earleywine has found that "the people who run into dependence problems with
cannabis are the ones who are drinking a lot of alcohol." He recommends
that medical cannabis users avoid alcohol consumption.

Attorney William Logan gave a talk entitled "Medicine Dances With
Lawyers,"explaining Prop 215 -California's Health & Safety Code Section
11362.5- and recounting the court rulings that affect its implementation.

Jensen's presentation was a version of what she teaches the first-year
students -"How do you tailor a history and physical to a medical marijuana
patient?... What dose and route of administration to use?... What strain to
use?" She also discussed "the advantages and disadvantages of having
medical marijuana patients in your practice." C-Notes will devote a column
in the near future to her observations.

Jensen had also invited -after getting administrative approval to do so-
Richard David, proprietor of the USA Hemp Museum, who brought samples of
hash, hash oil and other cannabis-based products, as well as some plant
strains (in jars), providing, for some of the students, a first exposure to
the once-prohibited herb

"How many of you use marijuana?" Jensen had asked. She says, "Probably
seven students raised their hands. I told them 'I am very proud of you
having the courage and the integrity to tell the truth, because that's what
this conference is about.'" Jensen also asked how many had or knew somebody
who had a condition treatable by cannabis. About 90% raised their hands.

Jensen says that the USC administration has been supportive of her efforts
to introduce cannabis into the curriculum. Althea Alexander, Clinical
Instructor for Educational Affairs, attended the Feb. 13 conference and
expressed gratitude to the patients who took part. Alexander regretted that
the event had been scheduled for the getaway day of President's Day
week-end; there would have been a much heavier turnout, she said, on an
ordinary Friday.

Jensen hopes that next year the conference will be held in October, "when
the students are freshest," and that it will be a requirement. (This year's
was not offered for credit.) Jensen had an insight about "elective"
classes when she was in med school at the start of the 1980s. "I took an
elective on 'Sexual Desensitization' and the only students who went to it
were the students who were comfortable with sexuality. All of the really
messed-up, up-tight people avoided it. So I don't think cannabis should be
an elective. I think it should be required training."

Jensen has also given thought to developing a continuing medical education
program for physicians, none of whom learned a thing about cannabis in
medical school. (Doctors are obligated to earn a certain number of CME
credits annually.) She has proposed to the administration that USC offer a
CME course on cannabis. Professor of Clinical Instruction Alan Abbott told
her he was amenable and would look into possible funding. Wouldn't such a
course pay for itself -or make money for the sponsor- Jensen was asked?
"Doctors are just scared of marijuana," she says. In 2000 she attended a
conference at UC San Francisco organized by Geoffrey Guy, MD, of GW
Pharmaceuticals. "It was poorly attended," she recalls.

Jensen thinks her colleagues in the medical profession will take steps to
educate themselves on the subject of cannabis only when they are obligated
to. And she has a strategy to obligate them. "The Medical Board of
California has dictated that physicians have to take eight hours in pain
management in order to maintain their licensure. My position is that any
pain management presentation that any physician takes is inadequate if it
does not include discussion about cannabis and cannabis compounds. The
Medical Board should take the position that cannabis teaching needs to be
integrated into those pain management sessions that physicians are already
required by law to attend."

Jensen is a pediatrician who practices in Ventura. She has a special
interest in cognitive function and development. She branched into treating
adults as a result of her interest in cannabis. She says that with every
patient she tries to figure out "the habits that are keeping them sick."

Jensen spends an hour seeing each new patient. She learned recently that
she is under investigation by the Medical Board for allegedly providing
substandard care to three ADHD patients (whose cannabis use she approved).